| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
52,550 |
47,558 |
$9.65M |
| 99499 |
|
1,790 |
1,731 |
$34K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17,184 |
16,056 |
$12K |
| 0012A |
|
282 |
279 |
$10K |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
591 |
390 |
$9K |
| 0011A |
|
291 |
285 |
$9K |
| 0002A |
|
248 |
244 |
$9K |
| G2025 |
Payment for a telehealth distant site service furnished by a rural health clinic (rhc) or federally qualified health center (fqhc) only |
107 |
96 |
$7K |
| 0001A |
|
205 |
196 |
$7K |
| 0072A |
|
110 |
104 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,341 |
3,194 |
$3K |
| 0064A |
|
88 |
82 |
$2K |
| 0071A |
|
71 |
69 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
2,300 |
2,179 |
$943.80 |
| 0502F |
|
161 |
138 |
$610.00 |
| 3079F |
|
353 |
320 |
$573.36 |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
3,414 |
3,357 |
$552.30 |
| 3078F |
|
1,037 |
911 |
$526.97 |
| 3077F |
|
136 |
132 |
$510.00 |
| 3074F |
|
1,253 |
1,093 |
$496.97 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
795 |
775 |
$320.00 |
| 99173 |
|
3,196 |
3,170 |
$267.30 |
| 92551 |
|
3,117 |
3,095 |
$246.37 |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
638 |
622 |
$237.42 |
| 3075F |
|
99 |
94 |
$213.35 |
| 3080F |
|
51 |
50 |
$200.00 |
| D1110 |
Prophylaxis - adult |
1,482 |
1,439 |
$189.60 |
| D0210 |
Intraoral - complete series of radiographic images |
310 |
304 |
$189.00 |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
1,074 |
1,070 |
$180.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
5,017 |
4,966 |
$103.50 |
| 3725F |
|
196 |
187 |
$90.00 |
| 90686 |
|
3,271 |
3,258 |
$81.10 |
| 81025 |
|
611 |
595 |
$76.00 |
| 83036 |
Hemoglobin; glycosylated (A1C) |
12 |
12 |
$70.00 |
| D9110 |
|
659 |
644 |
$60.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
656 |
633 |
$44.00 |
| D0120 |
Periodic oral evaluation - established patient |
1,215 |
1,189 |
$40.00 |
| 90715 |
|
43 |
42 |
$37.50 |
| 90461 |
|
2,433 |
2,421 |
$25.01 |
| D0190 |
|
93 |
90 |
$20.00 |
| 90619 |
|
12 |
12 |
$20.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
750 |
739 |
$20.00 |
| 36415 |
Collection of venous blood by venipuncture |
776 |
741 |
$13.28 |
| G0008 |
Administration of influenza virus vaccine |
76 |
67 |
$10.00 |
| 96127 |
|
520 |
518 |
$6.64 |
| 85018 |
|
652 |
641 |
$3.23 |
| 91300 |
|
101 |
93 |
$0.11 |
| 91307 |
|
32 |
31 |
$0.03 |
| D0220 |
Intraoral - periapical first radiographic image |
1,765 |
1,724 |
$0.00 |
| 1159F |
|
1,365 |
1,190 |
$0.00 |
| 1160F |
|
1,380 |
1,207 |
$0.00 |
| 90734 |
|
181 |
180 |
$0.00 |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
872 |
858 |
$0.00 |
| D1120 |
Prophylaxis - child |
794 |
790 |
$0.00 |
| 90670 |
|
401 |
400 |
$0.00 |
| D0274 |
Bitewings - four radiographic images |
1,118 |
1,099 |
$0.00 |
| 90633 |
|
264 |
264 |
$0.00 |
| 99395 |
Periodic comprehensive preventive medicine reevaluation, established patient, 18-39 years |
200 |
175 |
$0.00 |
| J1050 |
Injection, medroxyprogesterone acetate, 1 mg |
264 |
262 |
$0.00 |
| 90671 |
|
97 |
96 |
$0.00 |
| 90658 |
|
106 |
106 |
$0.00 |
| D0330 |
Panoramic radiographic image |
117 |
116 |
$0.00 |
| 90700 |
|
15 |
15 |
$0.00 |
| 90710 |
|
49 |
49 |
$0.00 |
| 82948 |
|
74 |
73 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
110 |
91 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
25 |
24 |
$0.00 |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
13 |
13 |
$0.00 |
| 82947 |
|
28 |
28 |
$0.00 |
| 87210 |
|
13 |
13 |
$0.00 |
| 90647 |
|
263 |
261 |
$0.00 |
| D0140 |
Limited oral evaluation - problem focused |
228 |
222 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
116 |
116 |
$0.00 |
| 90651 |
|
241 |
239 |
$0.00 |
| 96161 |
|
181 |
180 |
$0.00 |
| D1330 |
|
783 |
768 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,218 |
1,197 |
$0.00 |
| D0603 |
|
410 |
410 |
$0.00 |
| 81000 |
|
160 |
141 |
$0.00 |
| 90723 |
|
289 |
288 |
$0.00 |
| 3008F |
|
1,915 |
1,624 |
$0.00 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
25 |
$0.00 |
| 1036F |
|
335 |
319 |
$0.00 |
| D1206 |
Topical application of fluoride varnish |
1,085 |
1,068 |
$0.00 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
247 |
201 |
$0.00 |
| 90620 |
|
69 |
67 |
$0.00 |
| 1034F |
|
63 |
59 |
$0.00 |
| D0602 |
|
378 |
375 |
$0.00 |
| 91306 |
|
13 |
12 |
$0.00 |
| 90677 |
|
49 |
48 |
$0.00 |
| 19499 |
|
13 |
13 |
$0.00 |
| 90696 |
|
16 |
16 |
$0.00 |
| D1351 |
Sealant - per tooth |
58 |
16 |
$0.00 |
| 99385 |
|
25 |
25 |
$0.00 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
114 |
114 |
$0.00 |
| 90657 |
|
13 |
13 |
$0.00 |
| 88150 |
|
42 |
42 |
$0.00 |